8ab928d83d200680d68ca42463e9e6d1 327737.pdf b595d3936f4df92b76a5ded0c5d73d5f46b9df85 327737.pdf 7c11520c875e001366e3f980b4df8844318cfee3c90392ce0cba73a9ee78f1ae 327737.pdf Title: Potential Biomarkers of Therapeutic Response to ECP in Solid Organ Transplantation Subject: DOI: 10.1097/TXD.0000000000001817 Transplantation Direct, Volume. 11, Issue. 9, 2 September 2025 Abstract. One of the major hurdles in solid organ transplantation is graft rejection, which must be prevented with lifelong general immunosuppression. However, modern maintenance immunosuppression is accompanied by serious side effects, such as an increased risk of infection and malignancies. The search for alternative therapies specifically controlling allogeneic responses is fueling renewed interest in extracorporeal photopheresis (ECP). Despite guideline indications for ECP in cardiothoracic transplantation, potential applications in liver and kidney transplantation have not been adequately investigated. Presently, limited understanding of the pharmacodynamic effects of ECP and lack of consensus biomarkers are hindering the development of standardized multiparametric assays to assess patient responses. This review explores current knowledge about immune responses after ECP in transplant recipients and collates a set of biomarkers associated with favorable treatment responses. Author: Hendrik Veltman Creator: Adobe InDesign 15.1 (Windows) Producer: Adobe PDF Library 15.0 CreationDate: Wed Sep 3 15:21:11 2025 CEST ModDate: Wed Sep 3 20:36:46 2025 CEST Custom Metadata: no Metadata Stream: yes Tagged: yes UserProperties: no Suspects: no Form: AcroForm JavaScript: no Pages: 7 Encrypted: no Page size: 558 x 774 pts Page rot: 0 File size: 762964 bytes Optimized: yes PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- HelveticaNeueLTStd-Bd Type 1C WinAnsi yes no yes 1513 0 XCLFLG+HelveticaNeueLTStd-HvEx Type 1C WinAnsi yes yes yes 1515 0 SabonLTStd-Roman Type 1C Custom yes no yes 1518 0 HelveticaNeueLTStd-MdEx Type 1C WinAnsi yes no yes 1520 0 HelveticaNeueLTStd-Roman Type 1C WinAnsi yes no yes 1522 0 ZapfDingbatsStd Type 1C Custom yes no yes 1525 0 HelveticaNeueLTStd-Lt Type 1C Custom yes no yes 1528 0 HelveticaNeueLTStd-Md Type 1C WinAnsi yes no yes 1530 0 HelveticaNeueLTStd-Hv Type 1C WinAnsi yes no yes 1532 0 HelveticaNeueLTStd-LtIt Type 1C Custom yes no yes 1535 0 HelveticaNeueLTStd-BdEx Type 1C WinAnsi yes no yes 1537 0 YENBMG+HelveticaNeueLTStd-Ex Type 1C WinAnsi yes yes yes 1539 0 QBHWOX+STIXGeneral-Regular Type 1C Custom yes yes yes 353 0 HelveticaNeueLTStd-LtCn Type 1C Custom yes no yes 358 0 HelveticaNeueLTStd-BdCn Type 1C WinAnsi yes no yes 357 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-04-24 04:55:14 CEST RepresentationInformation: 327737.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-04-23 12:14:20 CEST Size: 762964 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf Profile: Linearized PDF PDFMetadata: Objects: 0 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: false CenterWindow: false DisplayDocTitle: true NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: OneColumn PageMode: UseOutlines Language: en-US Outlines: Item: Title: Potential Biomarkers of Therapeutic Response to ECP in Solid Organ Transplantation Children: Item: Title: COMPOSITION OF PHERESATES AND ITS SYSTEMIC EFFECTS Item: Title: IMMUNE MODULATORY EFFECTS OF ECP IN SOT Children: Item: Title: Dendritic Cells Item: Title: T Cells Item: Title: Macrophages Item: Title: Natural Killer Cells Item: Title: B Cells Item: Title: Myeloid-derived Suppressor Cells Item: Title: ADVANCING PREDICTIVE TOOLS FOR ECP RESPONSE IN SOT Item: Title: CONCLUSIONS Item: Title: REFERENCES Item: Title: Potential Biomarkers of Therapeutic Response to ECP in Solid Organ Transplantation Children: Item: Title: COMPOSITION OF PHERESATES AND ITS SYSTEMIC EFFECTS Item: Title: IMMUNE MODULATORY EFFECTS OF ECP IN SOT Children: Item: Title: Dendritic Cells Item: Title: T Cells Item: Title: Macrophages Item: Title: Natural Killer Cells Item: Title: B Cells Item: Title: Myeloid-derived Suppressor Cells Item: Title: ADVANCING PREDICTIVE TOOLS FOR ECP RESPONSE IN SOT Item: Title: CONCLUSIONS Item: Title: REFERENCES Item: Title: Potential Biomarkers of Therapeutic Response to ECP in Solid Organ Transplantation Children: Item: Title: COMPOSITION OF PHERESATES AND ITS SYSTEMIC EFFECTS Item: Title: IMMUNE MODULATORY EFFECTS OF ECP IN SOT Children: Item: Title: Dendritic Cells Item: Title: T Cells Item: Title: Macrophages Item: Title: Natural Killer Cells Item: Title: B Cells Item: Title: Myeloid-derived Suppressor Cells Item: Title: ADVANCING PREDICTIVE TOOLS FOR ECP RESPONSE IN SOT Item: Title: CONCLUSIONS Item: Title: REFERENCES Item: Title: Potential Biomarkers of Therapeutic Response to ECP in Solid Organ Transplantation Children: Item: Title: COMPOSITION OF PHERESATES AND ITS SYSTEMIC EFFECTS Item: Title: IMMUNE MODULATORY EFFECTS OF ECP IN SOT Children: Item: Title: Dendritic Cells Item: Title: T Cells Item: Title: Macrophages Item: Title: Natural Killer Cells Item: Title: B Cells Item: Title: Myeloid-derived Suppressor Cells Item: Title: ADVANCING PREDICTIVE TOOLS FOR ECP RESPONSE IN SOT Item: Title: CONCLUSIONS Item: Title: REFERENCES Filters: FilterPipeline: FlateDecode FilterPipeline: DCTDecode Images: Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 97 ImageHeight: 37 BitsPerSample: 8 BitsPerSampleUnit: integer ColorSpace: Separation Intent: RelativeColorimetric Name: X Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1300 ImageHeight: 657 ColorSpace: CMYK BitsPerSample: 8 BitsPerSampleUnit: integer Intent: RelativeColorimetric Name: X Fonts: Type1: Font: BaseFont: HelveticaNeueLTStd-BdEx FirstChar: 0 LastChar: 255 FontDescriptor: FontName: HelveticaNeueLTStd-BdEx Flags: Nonsymbolic FontBBox: -145, -213, 1163, 984 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: QBHWOX+STIXGeneral-Regular FontSubset: true FirstChar: 26 LastChar: 33 FontDescriptor: FontName: QBHWOX+STIXGeneral-Regular Flags: Serif, Symbolic FontBBox: -995, -455, 2000, 1055 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: YENBMG+HelveticaNeueLTStd-Ex FontSubset: true FirstChar: 0 LastChar: 255 FontDescriptor: FontName: YENBMG+HelveticaNeueLTStd-Ex Flags: Nonsymbolic FontBBox: -157, -220, 1160, 963 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: HelveticaNeueLTStd-BdCn FirstChar: 0 LastChar: 255 FontDescriptor: FontName: HelveticaNeueLTStd-BdCn Flags: Nonsymbolic FontBBox: -164, -224, 1066, 961 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: HelveticaNeueLTStd-LtCn FirstChar: 0 LastChar: 255 FontDescriptor: FontName: HelveticaNeueLTStd-LtCn Flags: Nonsymbolic FontBBox: -167, -204, 1000, 927 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: HelveticaNeueLTStd-Bd FirstChar: 0 LastChar: 255 FontDescriptor: FontName: HelveticaNeueLTStd-Bd Flags: Nonsymbolic FontBBox: -166, -218, 1078, 975 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: XCLFLG+HelveticaNeueLTStd-HvEx FontSubset: true FirstChar: 0 LastChar: 255 FontDescriptor: FontName: XCLFLG+HelveticaNeueLTStd-HvEx Flags: Nonsymbolic FontBBox: -200, -223, 1297, 999 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: SabonLTStd-Roman FirstChar: 0 LastChar: 255 FontDescriptor: FontName: SabonLTStd-Roman Flags: Serif, Nonsymbolic FontBBox: -165, -228, 1000, 944 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: HelveticaNeueLTStd-MdEx FirstChar: 0 LastChar: 255 FontDescriptor: FontName: HelveticaNeueLTStd-MdEx Flags: Nonsymbolic FontBBox: -172, -220, 1159, 978 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: HelveticaNeueLTStd-Roman FirstChar: 0 LastChar: 255 FontDescriptor: FontName: HelveticaNeueLTStd-Roman Flags: Nonsymbolic FontBBox: -166, -214, 1076, 952 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: ZapfDingbatsStd FirstChar: 0 LastChar: 255 FontDescriptor: FontName: ZapfDingbatsStd Flags: Symbolic FontBBox: -1, -143, 981, 820 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: HelveticaNeueLTStd-Lt FirstChar: 0 LastChar: 255 FontDescriptor: FontName: HelveticaNeueLTStd-Lt Flags: Nonsymbolic FontBBox: -166, -214, 1050, 967 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: HelveticaNeueLTStd-Md FirstChar: 0 LastChar: 255 FontDescriptor: FontName: HelveticaNeueLTStd-Md Flags: Nonsymbolic FontBBox: -165, -221, 1066, 952 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: HelveticaNeueLTStd-Hv FirstChar: 0 LastChar: 255 FontDescriptor: FontName: HelveticaNeueLTStd-Hv Flags: Nonsymbolic FontBBox: -169, -234, 1096, 951 FontFile3: true Encoding: WinAnsiEncoding ToUnicode: true Font: BaseFont: HelveticaNeueLTStd-LtIt FirstChar: 0 LastChar: 255 FontDescriptor: FontName: HelveticaNeueLTStd-LtIt Flags: Nonsymbolic, Italic FontBBox: -165, -214, 1099, 951 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true XMP: application/pdf Potential Biomarkers of Therapeutic Response to ECP in Solid Organ Transplantation DOI: 10.1097/TXD.0000000000001817 Transplantation Direct, Volume. 11, Issue. 9, 2 September 2025 Abstract. One of the major hurdles in solid organ transplantation is graft rejection, which must be prevented with lifelong general immunosuppression. However, modern maintenance immunosuppression is accompanied by serious side effects, such as an increased risk of infection and malignancies. The search for alternative therapies specifically controlling allogeneic responses is fueling renewed interest in extracorporeal photopheresis (ECP). Despite guideline indications for ECP in cardiothoracic transplantation, potential applications in liver and kidney transplantation have not been adequately investigated. Presently, limited understanding of the pharmacodynamic effects of ECP and lack of consensus biomarkers are hindering the development of standardized multiparametric assays to assess patient responses. This review explores current knowledge about immune responses after ECP in transplant recipients and collates a set of biomarkers associated with favorable treatment responses. Copyright © 2025 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. Hendrik Veltman Eva Martinez-Caceres Maria Iglesias-Escudero 2025-09-03T18:51:11+05:30 Adobe InDesign 15.1 (Windows) 2025-09-04T00:06:46+05:30 2025-09-04T00:06:46+05:30 uuid:a84f102f-7213-4a82-87b3-edca91f93e54 xmp.did:07801174072068118C149D4CFFA16D8F xmp.id:fcd76835-f9b4-a341-819f-b82c3239b95f proof:pdf 1 xmp.iid:efeeebec-20d9-9b45-a8c6-c6536bee60cb xmp.did:cac0975f-97b2-9d4c-9317-450dcf055b29 default converted from application/x-indesign to application/pdf Adobe InDesign 15.1 (Windows) 2025-09-03T18:51:11+05:30 converted uuid:262123d0-b785-4046-be21-f37c30ac75e3 converted to PDF/A-3a Preflight 2025-09-03T18:52:42+05:30 converted uuid:ee998241-5eac-462a-b84e-b873193a808c PDF/A conversion failed; Version and conformance level identification removed Preflight 2025-09-03T18:52:45+05:30 converted uuid:786a9049-30a1-4670-8420-e9c0d38ef8d2 converted to PDF/A-3a Preflight 2025-09-04T00:06:45+05:30 True Adobe PDF Library 15.0 False 1 3 A http://ns.adobe.com/pdf/1.3/ pdf Adobe PDF Schema internal A name object indicating whether the document has been modified to include trapping information Trapped Text http://ns.adobe.com/xap/1.0/mm/ xmpMM XMP Media Management Schema internal UUID based identifier for specific incarnation of a document InstanceID URI internal The common identifier for all versions and renditions of a document. OriginalDocumentID URI http://www.aiim.org/pdfa/ns/id/ pdfaid PDF/A ID Schema internal Part of PDF/A standard part Integer internal Amendment of PDF/A standard amd Text internal Conformance level of PDF/A standard conformance Text http://www.aiim.org/pdfua/ns/id/ pdfuaid PDF/UA ID Schema internal Part of PDF/UA standard part Integer Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Contents: Rect: 107, 629, 120, 617 Flags: Print AppearanceDictionary: true Annotation: Subtype: Link Contents: 1 Rect: 143, 629, 143, 616 Flags: Print AppearanceDictionary: true Annotation: Subtype: Link Contents: 2 Rect: 146, 629, 149, 616 Flags: Print AppearanceDictionary: true Destination: 1450 Annotation: Subtype: Link Contents: 1 Rect: 151, 629, 154, 616 Flags: Print AppearanceDictionary: true Destination: 1450 Annotation: Subtype: Link Contents: 2 Rect: 282, 629, 282, 616 Flags: Print AppearanceDictionary: true Annotation: Subtype: Link Contents: 3 Rect: 285, 629, 288, 616 Flags: Print AppearanceDictionary: true Destination: 1450 Annotation: Subtype: Link Contents: 1 Rect: 290, 629, 293, 616 Flags: Print AppearanceDictionary: true Destination: 1450 Annotation: Subtype: Link Contents: 2 Rect: 295, 629, 298, 616 Flags: Print AppearanceDictionary: true Destination: 1450 Annotation: Subtype: Link Contents: Rect: 427, 629, 439, 617 Flags: Print AppearanceDictionary: true Annotation: Subtype: Link Contents: 3 Rect: 462, 629, 466, 616 Flags: Print AppearanceDictionary: true Destination: 1450 Annotation: Subtype: Link Contents: 1 Rect: 468, 629, 471, 616 Flags: Print AppearanceDictionary: true Destination: 1450 Annotation: Subtype: Link Contents: 2 Rect: 473, 629, 476, 616 Flags: Print AppearanceDictionary: true Destination: 1450 Annotation: Subtype: Link Contents: Figure 1). To these WBCs, 8-methoxypsoralen (8-MOP) is then added, which binds intercalates into DNA, sensitizing cells to U嘀䄀 氀椀最栀琀⸀ 伀渀 唀嘀䄀 椀爀爀愀搀椀愀琀椀漀渀Ⰰ 㠀ⴀ䴀伀倀 昀漀爀洀猀 挀漀瘀愀氀攀渀琀 䐀一䄀 愀搀搀甀挀琀猀 琀栀愀琀 爀攀猀甀氀琀 椀渀 搀漀甀戀氀攀ⴀ猀琀爀愀渀搀攀搀 䐀一䄀 戀爀攀愀欀猀Ⰰ 眀栀椀挀栀 琀爀椀最最攀爀 愀瀀漀瀀琀漀猀s in treated cells. The resulting mixture of living and dying leuko-cytes, as well as the conditioned plasma in which they are 猀甀猀ⴀ瀀攀渀搀攀搀Ⰰ 椀猀 挀愀氀氀攀搀 愀†ᰀ瀀栀漀琀漀瀀栀攀爀攀猀愀琀攀⸠ᴀ 吀栀椀猀 椀洀洀甀渀漀氀漀最椀挀愀氀氀礀 挀漀洀瀀氀攀砀 瀀爀漀搀甀挀琀 椀猀 琀栀攀渀 爀攀椀渀昀甀猀攀搀 椀渀琀漀 瀀愀琀椀攀渀琀猀⸀㌩⽄敳琨㈲彔塄ⴲ〲㐭〲㘵⹩湤携䅮捨潲‸㨳〹 Rect: 69, 400, 71, 390 Flags: Print AppearanceDictionary: true Annotation: Subtype: Link Contents: Figure 1). To these WBCs, 8-methoxypsoralen (8-MOP) is then added, which binds intercalates into DNA, sensitizing cells to U嘀䄀 氀椀最栀琀⸀ 伀渀 唀嘀䄀 椀爀爀愀搀椀愀琀椀漀渀Ⰰ 㠀ⴀ䴀伀倀 昀漀爀洀猀 挀漀瘀愀氀攀渀琀 䐀一䄀 愀搀搀甀挀琀猀 琀栀愀琀 爀攀猀甀氀琀 椀渀 搀漀甀戀氀攀ⴀ猀琀爀愀渀搀攀搀 䐀一䄀 戀爀攀愀欀猀Ⰰ 眀栀椀挀栀 琀爀椀最最攀爀 愀瀀漀瀀琀漀猀s in treated cells. The resulting mixture of living and dying leuko-cytes, as well as the conditioned plasma in which they are 猀甀猀ⴀ瀀攀渀搀攀搀Ⰰ 椀猀 挀愀氀氀攀搀 愀†ᰀ瀀栀漀琀漀瀀栀攀爀攀猀愀琀攀⸠ᴀ 吀栀椀猀 椀洀洀甀渀漀氀漀最椀挀愀氀氀礀 挀漀洀瀀氀攀砀 瀀爀漀搀甀挀琀 椀猀 琀栀攀渀 爀攀椀渀昀甀猀攀搀 椀渀琀漀 瀀愀琀椀攀渀琀猀⸀㌩⽄敳琨㈲彔塄ⴲ〲㐭〲㘵⹩湤携䅮捨潲‹㨳㄰ Rect: 227, 378, 230, 368 Flags: Print AppearanceDictionary: true Annotation: Subtype: Link Contents: 1 Rect: 425, 389, 457, 379 Flags: Print AppearanceDictionary: true Destination: 1 Annotation: Subtype: Link Contents: 4 Rect: 480, 301, 483, 291 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 5 Rect: 408, 246, 411, 236 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 6 Rect: 404, 213, 407, 203 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 6 Rect: 483, 191, 486, 181 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 7 Rect: 487, 191, 490, 181 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 8 Rect: 336, 136, 339, 126 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: miglesiase.germanstrias@gencat.cat Rect: 342, 136, 345, 126 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) Rect: 328, 81, 331, 71 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) Rect: 146, 139, 256, 131 Flags: Print AppearanceDictionary: true Annotation: Subtype: Link Contents: 9 Rect: 47, 109, 273, 101 Flags: Print AppearanceDictionary: true Annotation: Subtype: Link Contents: 12 Rect: 36, 100, 81, 92 Flags: Print AppearanceDictionary: true Page: Sequence: 2 Annotations: Annotation: Subtype: Link Contents: 13 Rect: 238, 376, 241, 365 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 15 Rect: 243, 376, 249, 365 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 14 Rect: 209, 189, 216, 178 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 16 Rect: 218, 189, 225, 178 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 3 Rect: 256, 167, 263, 156 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 14 Rect: 264, 167, 270, 156 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 17 Rect: 92, 134, 95, 123 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 13 Rect: 97, 134, 103, 123 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 18 Rect: 104, 134, 111, 123 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 19 Rect: 121, 90, 127, 79 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 20 Rect: 128, 90, 134, 79 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 21 Rect: 51, 46, 57, 35 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 21 Rect: 396, 376, 402, 365 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 22 Rect: 403, 376, 409, 365 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 23 Rect: 416, 365, 422, 354 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 24 Rect: 508, 310, 514, 299 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 29 Rect: 516, 310, 522, 299 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 24 Rect: 390, 289, 396, 275 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 29 Rect: 398, 289, 403, 275 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 29 Rect: 337, 266, 343, 255 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 30 Rect: 344, 266, 350, 255 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 24 Rect: 456, 244, 461, 233 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 31 Rect: 463, 244, 469, 233 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 32 Rect: 406, 211, 412, 200 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 33 Rect: 415, 211, 421, 200 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 34 Rect: 473, 134, 479, 123 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 13 Rect: 312, 90, 318, 79 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 35 Rect: 328, 57, 334, 46 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: https://BioRender.com/1qaq2hv Rect: 508, 46, 514, 35 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 35 Rect: 516, 46, 522, 35 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 36 Rect: 139, 435, 250, 425 Flags: Print AppearanceDictionary: true Page: Sequence: 3 Annotations: Annotation: Subtype: Link Contents: 39 Rect: 150, 565, 156, 554 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 40 Rect: 74, 510, 80, 499 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 41 Rect: 82, 510, 88, 499 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 42 Rect: 92, 466, 98, 455 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 43 Rect: 74, 444, 80, 433 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 44 Rect: 81, 444, 87, 433 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 45 Rect: 54, 411, 60, 400 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 47 Rect: 167, 389, 173, 378 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 48 Rect: 192, 298, 198, 284 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 45 Rect: 199, 298, 205, 284 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 49 Rect: 267, 264, 273, 253 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 50 Rect: 195, 231, 201, 220 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 51 Rect: 202, 231, 208, 220 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 52 Rect: 267, 165, 273, 154 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 53 Rect: 231, 132, 236, 121 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 54 Rect: 113, 99, 118, 88 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 55 Rect: 115, 66, 121, 55 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 56 Rect: 176, 66, 182, 55 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 57 Rect: 249, 44, 254, 33 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 58 Rect: 402, 689, 408, 678 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 59 Rect: 511, 645, 517, 634 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 58 Rect: 519, 645, 525, 634 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 60 Rect: 440, 590, 446, 579 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 61 Rect: 440, 568, 445, 557 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 62 Rect: 466, 524, 471, 513 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 63 Rect: 509, 502, 515, 491 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 64 Rect: 516, 502, 522, 491 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 66 Rect: 411, 399, 417, 389 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 65 Rect: 467, 377, 472, 367 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 66 Rect: 474, 377, 480, 367 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 66 Rect: 366, 355, 372, 345 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 67 Rect: 374, 355, 380, 345 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 68 Rect: 519, 333, 525, 323 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 69 Rect: 475, 311, 481, 301 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 70 Rect: 382, 187, 388, 176 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 71 Rect: 455, 121, 461, 110 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 72 Rect: 372, 77, 378, 66 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 73 Rect: 379, 77, 385, 66 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 74 Rect: 449, 77, 455, 66 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 75 Rect: 480, 66, 485, 55 Flags: Print AppearanceDictionary: true Destination: 16 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Contents: 76 Rect: 257, 462, 263, 451 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 77 Rect: 264, 462, 270, 451 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 78 Rect: 102, 440, 108, 429 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 79 Rect: 264, 418, 270, 407 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 80 Rect: 259, 374, 265, 363 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 78 Rect: 232, 308, 238, 297 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 81 Rect: 265, 286, 270, 275 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 83 Rect: 224, 264, 229, 253 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 84 Rect: 107, 182, 113, 171 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 85 Rect: 115, 182, 121, 171 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 86 Rect: 151, 160, 157, 149 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 87 Rect: 140, 127, 146, 116 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 88 Rect: 147, 127, 153, 116 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 73 Rect: 39, 83, 45, 72 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: Table 1 Rect: 181, 50, 187, 39 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 4 Rect: 396, 440, 402, 429 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 94 Rect: 429, 396, 458, 385 Flags: Print AppearanceDictionary: true Destination: 7 Annotation: Subtype: Link Contents: 97 Rect: 376, 303, 378, 292 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 4 Rect: 380, 303, 386, 292 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 94 Rect: 387, 303, 393, 292 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 95 Rect: 436, 259, 439, 248 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 98 Rect: 440, 259, 446, 248 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 99 Rect: 447, 259, 453, 248 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 89 Rect: 399, 105, 405, 94 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 38 Rect: 366, 83, 372, 72 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 90 Rect: 114, 654, 118, 642 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 57 Rect: 476, 673, 481, 664 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 58 Rect: 482, 673, 486, 664 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 60 Rect: 180, 635, 185, 622 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 61 Rect: 186, 635, 191, 622 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 91 Rect: 388, 634, 392, 624 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 38 Rect: 393, 634, 398, 624 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 92 Rect: 262, 613, 266, 604 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 50 Rect: 435, 623, 439, 614 Flags: Print AppearanceDictionary: true Destination: 14 Annotation: Subtype: Link Contents: 53 Rect: 218, 602, 223, 593 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 55 Rect: 409, 592, 414, 583 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 93 Rect: 415, 592, 420, 583 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 63 Rect: 421, 592, 425, 583 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 66 Rect: 426, 592, 431, 583 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 67 Rect: 291, 572, 295, 560 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 68 Rect: 380, 571, 385, 562 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 68 Rect: 386, 571, 390, 562 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 72 Rect: 160, 552, 165, 540 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 73 Rect: 353, 541, 357, 532 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 85 Rect: 358, 541, 363, 532 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 86 Rect: 364, 541, 369, 532 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 81 Rect: 186, 520, 191, 511 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 83 Rect: 192, 520, 196, 511 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 100 Rect: 410, 530, 415, 521 Flags: Print AppearanceDictionary: true Destination: 16 Annotation: Subtype: Link Contents: 102 Rect: 416, 530, 421, 521 Flags: Print AppearanceDictionary: true Destination: 16 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Contents: 103 Rect: 117, 721, 126, 711 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 104 Rect: 128, 721, 136, 711 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 104 Rect: 129, 677, 138, 667 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 103 Rect: 139, 677, 148, 667 Flags: Print AppearanceDictionary: true Destination: 18 Annotation: Subtype: Link Contents: 104 Rect: 111, 644, 119, 634 Flags: Print AppearanceDictionary: true Destination: 18 Page: Sequence: 6 Page: Sequence: 7 Checksum: f9bbe8ee Type: CRC32 Checksum: 8ab928d83d200680d68ca42463e9e6d1 Type: MD5 Checksum: b595d3936f4df92b76a5ded0c5d73d5f46b9df85 Type: SHA-1 Checksum: 7c11520c875e001366e3f980b4df8844318cfee3c90392ce0cba73a9ee78f1ae Type: SHA-256